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07-05-2012 | General practice | Article

Dental visits low among patients with chronic kidney disease


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MedWire News: Very few patients with chronic kidney disease (CKD) regularly visit a dentist, despite evidence linking poor oral health to progression of the condition, study findings indicate.

Research has shown a strong link between the presence of periodontal disease and increased risk for CKD, even after accounting for confounders such as diabetes, tobacco use, and socioeconomic status.

Thus, it could be argued that CKD patients should have more intense dental observation. However, such patients may be less likely to seek and attend dental appointments because of conflicting medical appointments, lifestyle changes required because of CKD, and reduced availability of preventive dental appointments through lack of funding.

In the present retrospective cohort analysis, Vanessa Grubbs (University of California, San Francisco, USA) and colleagues examined dental visits among adults (aged 20 years or older) in the San Francisco Department of Public Health Community Health Network.

Participants with (n=2235) or without (n=4263) CKD were followed up for at least 12 months and the number of dental visits between 2005 and 2010 were recorded. CKD was defined as an estimated glomerular filtration rates of less than 60 mL/min/1.73m2 on two separate occasions at least 3 months apart.

As a control, the authors also examined the use of appointments for eye checks among a subgroup of patients with diabetes.

Of the patients examined, 50% were male and most were aged 46 years or older.

Only 15.2% of the entire patient population studied had a dental visit during the observed period. Patients with CKD had significantly fewer dental visits than those without CKD (11.0 vs 17.4%).

In a Cox proportional hazards model, patients with CKD had 27% lower likelihood for a dental visit (hazard ratio [HR]=0.73) compared with those without CKD. This association remained after adjusting for gender, race/ethnicity, language preference, insurance, and monthly income (HR=0.75).

The likelihood for attending a dental visit decreased as patients got older (HR=0.46 for patients aged >65 years vs patients aged 20-45 years) and Black people were nearly twice as likely to attend visits (HR=1.88) as White people.

While the percentage of patients attending a dental visit was similar between those with and without diabetes, eye visits were significantly higher in those patients with diabetes (58 vs 27%).

Writing in BMC Nephrology, the authors conclude: "The percentage of patients with dental care within a public healthcare setting is strikingly low overall, but particularly among those with CKD."

"Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population."

By Iain Bartlett

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